Provider Demographics
NPI:1063867034
Name:ADAMS, SHANOTRA (LPN)
Entity Type:Individual
Prefix:
First Name:SHANOTRA
Middle Name:
Last Name:ADAMS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 HUDSON TRCE STE 217
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30907-2010
Mailing Address - Country:US
Mailing Address - Phone:706-750-2300
Mailing Address - Fax:706-553-8241
Practice Address - Street 1:207 HUDSON TRCE STE 217
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30907-2010
Practice Address - Country:US
Practice Address - Phone:706-750-2300
Practice Address - Fax:706-553-8241
Is Sole Proprietor?:No
Enumeration Date:2016-04-27
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALCB20160000533372600000X, 3747P1801X, 376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No376K00000XNursing Service Related ProvidersNurse's Aide